Question 1. Which medication(s) would you administer to Bob now based on the above information you have been given? And Why? Provide a detailed rationale for your answer (use an array of literature to support your choice)
Question 2. Working as a nurse requires a multidisciplinary team approach. Select one member of the multidisciplinary team (NOT a medical practitioner) that you would engage in Bob’s care throughout his hospital admission. Provide a detailed rationale for your answer (use an array of literature to support your choice)
Mr Bob Jackson has been admitted in to the emergency department with an increasing abdominal a pain and diarrhoea for the past few weeks. The symptoms manifested by Bob Jackson is more like an ulcerative colitis. The symptoms shown by Bob are lower abdominal pain in the left quadrant of the abdomen with a constant dull ache all the time which increases to a strong pressure on the body. This assignment would describe about the medicines and their working mechanism with a suitable rationale behind their use. The clinical issue faced by Bob Jackson required a multidisciplinary approach and the final part of the assignment would give an account of a registered dietician for managing the dietary habit of Bob.
Management of pain in ulcerative colitis can be difficult as most of the pain killers can flare up the conditions. It can be seen from the case study that Celebrex had been administered to Bob. A randomise control trial has proved Celebrex to be much effective managing pain in ulcerative colitis compared to other non-steroidal anti-inflammatory drug therapy. Celebrex belongs to the class of drug called the Celecoxib that prevents the synthesis of prostaglandin (that is responsible for the pain) by the inhibition of the enzyme known as cyclooxygenase 2 (Setia, Nehru & Sanyal, 2014). Most of the NSAIDs inhibits both COX-1 and COX-2, but Celebrex is the selective inhibitor of only COX-2.
The working principle of the Endone tablets are similar to the action of the opioid analgesics and can be used to treat moderate to severe pain as in Bob. The active ingredient for this medicine is an opioid that is known as oxycodone hydrochloride. It works by activating the opioid receptors in the central nervous system interfering with the transmission of the pain signals through the central nervous system and thus reduces the sensation of pain (Aronson, 2015).
Amino salicylates should not be given to Bob for treating mild to moderate ulcerative colitis. Amino salicylates such as Mesalamine can be given to prevent the symptoms from recurring. Mesalamine stops the inflammation by blocking the cyclooxygenase and the inhibition of the prostaglandin production in the colon, but might cause several side effects like dizziness and can also be associated with kidney problems (Aronson, 2015).
Corticosteroids can also be used orally or intravenously for reducing the inflammation in the lining of the intestine (Li et al., 2015). But corticosteroids might not be used for long term as it can cause steroid dependence in the patient. Although paracetamol is a weak inhibitor of prostaglandin but it might not be suitable for Bob as paracetamol might not work for severe pain (J??wiak-Bebenista, & Nowak, 2014). It should be remembered that administration of the painkillers is associated with several side effects such as dizziness, breathing problems and disorientation, hence clinical professionals should be acquainted with the medical history of the patient and the dosage of the medicines before their administration to avoid any contraindications (Aronson, 2015).
Ulcerative colitis has been found to be associated with extra-intestinal manifestations and requires a multidisciplinary care approach for assessing the entire disease spectrum of the patient with ulcerative colitis. Apart from the health professionals such as the doctors and the nurses, a registered dietician is also required for Bob (Ghosh, 2013).
A registered dietician promotes healthy diet and nutrition to the patient in the hospital according to the nutritional requirement of the patient’s condition. A dietician is the one that is responsible for informing the patient about healthy diet, the possible food allergies and the intolerances (Ghosh, 2013).
Active disease like ulcerative colitis increases the body’s requirements for the nutrients, energy and the calories. When the disease flare up it can become difficult to maintain adequate nutrition. A dietician can recommend sufficient protein and calorie uptake for meeting the calorie requirement of bob. According to Lee et al., (2015), dietary habits can be the etiological factors for the progression of ulcerative colitis. Abdominal pain, discomfort, diarrhoea can be associated with poor nutrition in Bob. Ananthakrishnan et al., (2012), have stated that there are certain foods that can actually exacerbate the symptoms of diarrhoea in patients. Studies have found that the high intake of dietary product and low fibres is associated with the relapse of ulcerative colitis. Again studies have proven that sulphur and sulphate might be the reason for the relapse of the disease (Lee et al., 2015). Hence the food choices of the patient often becomes the predisposing factors for the gastrointestinal disorders. A dietician will recommend the choice of food such as probiotics or folic acid supplements in the diet. Folic acid deficiency has been found to be associated with the colitis associated carcinogenesis. Probiotic bacteria influence the activity of the immune cells and the cells lining the intestine. The probiotic bacteria competitively inhibits the disease causing bacteria from causing the inflammation (Moayyedi et al., 2013). As per the case study, Bob Jackson had been suffering from osteoarthritis and joint pain which can be associated with the relative loss of the bone mineral density. Hence a registered dietician can also plan iron rich diet for (Bob Baker, & Isaacs, 2018).
As per the case study and the symptoms manifested by Bob Jackson, pain management is one of the clinical priority. The report had described the effects of each of the medications like Endone, paracetamol, Celebrex and corticosteroids and Celebrex and antibiotics have been selected as the choice of drugs for Bob, as per his medical condition. Furthermore the assignment had also focussed on the requirement of a registered dietician for assessing the nutritional requirement of Bob. The assignment had rightfully mentioned about the contraindications that can occur due to the painkillers and have also provided an in depth discussion regarding the role of diet in managing the symptoms of ulcerative colitis.
However, bob Jackson required a comprehensive holistic care approach to prevent the progression and he relapse of the disease.
Ananthakrishnan, A. N., Khalili, H., Konijeti, G. G., Higuchi, L. M., de Silva, P., Fuchs, C. S., ... & Chan, A. T. (2014). Long-term intake of dietary fat and risk of ulcerative colitis and Crohn's disease. Gut, 63(5), 776-784.
Aronson, J. K. (Ed.). (2015). Meyler's side effects of drugs: the international encyclopedia of adverse drug reactions and interactions. Elsevier.
Baker, K. F., & Isaacs, J. D. (2018). Novel therapies for immune-mediated inflammatory diseases: What can we learn from their use in rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, psoriasis, Crohn’s disease and ulcerative colitis?. Annals of the rheumatic diseases, 77(2), 175-187. 10.3748/wjg.v21.i10.3005
Ghosh, S. (2013). Multidisciplinary teams as standard of care in inflammatory bowel disease. Canadian Journal of Gastroenterology, 27(4), 198.
J??wiak-Bebenista, M., & Nowak, J. Z. (2014). Paracetamol: mechanism of action, applications and safety concern. Acta poloniae pharmaceutica, 71(1), 11-23.
Lee, D., Albenberg, L., Compher, C., Baldassano, R., Piccoli, D., Lewis, J. D., & Wu, G. D. (2015). Diet in the pathogenesis and treatment of inflammatory bowel diseases. Gastroenterology, 148(6), 1087-1106.
Li, J., Wang, F., Zhang, H. J., Sheng, J. Q., Yan, W. F., Ma, M. X., ... & Zheng, P. (2015). Corticosteroid therapy in ulcerative colitis: clinical response and predictors. World Journal of Gastroenterology: WJG, 21(10), 3005. 10.3748/wjg.v21.i10.3005
Moayyedi, P., Surette, M. G., Kim, P. T., Libertucci, J., Wolfe, M., Onischi, C., ... & Lee, C. H. (2015). Fecal microbiota transplantation induces remission in patients with active ulcerative colitis in a randomized controlled trial. Gastroenterology, 149(1), 102-109.
Setia, S., Nehru, B., & Sanyal, S. N. (2014). Celecoxib prevents colitis associated colon carcinogenesis: an upregulation of apoptosis. Pharmacological Reports, 66(6), 1083-1091.